Don Peebles - 1664 Meridian, LLC Pv.r 1(11\5 Le+.
RECEIVED
JUN
AIV\I
E.
M�qM�8
1to Office of the City Clerk �� �
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1700 Convention Center Drive
Miami Beach, FL 33139 C11Y OF
305.673.7411 OFFICE OF THE CiTy�ra H
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
Manager or any City board or committee;or any action, decision or recommendation of any City personnel during the time period of the
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the City
Commission, or a City board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term"Lobbyist"has specific exclusions. Please refer to City Code Chapter 2, Article VII, Division 3, entitled "Lobbyists,"
for additional information.
Instructions: Please complete all sections•of this form and submit the completed form,with the applicable fee, to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Peebles Don
NAME OF LOBBYIST (Last) (First) (Middle Name)
1664 Meridian, LLC 13876 SW 56TH ST., #268 Miami FL 33175
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) ,(State) (Zip Code)
305.993.5050 donpeebles@peeblescorp.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Peebles Don
NAME OF PRINCIPAL (Last) (First) (Middle Name)
1664 Meridian, LLC 13876 SW 56 ST., #268 Miami FL 33175
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.993.5050 donpeebles@ peeblescorp.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant to'C.4,POder Section 2 482(h)(1)(a) A:pnncrpaI of any corporation partnership or.other.entity who,,appears as.a.lobbyist on behalf of that
entity,without special:compensation or,reimbursement for the appearance whether direct'indirect or contingent,to'express support of or opposition to
an item shall:register.withthe:Clerk as required by this subsection;:but"shall not,be r'equiredaopay any registration fees.
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write NIA):
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5pp%�1OR MORE OWNERSHIP INTEREST� IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write NIA):Tt.e Q Si see l�l a c 1 °
Page 1 of 5 scanned
AUG 1 5 2622:. ��
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Negotiation and approval of development agreement and lease, development and permitting approvals,
including, but not limited to Members of City Administration, Members of City Staff and Members of
Planning Board, Design Review Board, Board of Adjustment, City Commission, and Mayor, relating to
the RFP for the Lincoln Lane project and development of P27 Parking Lot.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship(If yes, explain) YES NO
Title of Person to be Lobbied •
Members of City Administration and Members City Staff X
Planning Board (PB) , Design Review Board (DRB) X
Board of Adjustment(BOA), City Commission and Mayor X
Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any
business, financial, familial or professional relationship, or other relationship giving rise to an
appearance of an impropriety, with any current City Commissioner or City personnel who is sought to
be lobbied as identified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
ad c1 i jion.l comp-ehSafian .
Page2of5
r1
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes XNo: Are you Iobbvina on a present or pending bid for goods, equipment or services, or on a present or
pending award for goods,equipment or service?
2) Pursuant to City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
—Yes XNo: Are you lobbying on a pending application for a Development Agreement with the City or application
for chancre of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481)who only appears as a representative of a not-for-profit corporation or entity without special compensation or
reimbursement for the appearance,whether direct or indirect to express support of or opposition to any item,shall register with
the city clerk as required by this section,but shall not be required to pay any registration fees.
_YesX_No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement? ,
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings;any person who only appears \
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes')(No: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the past election cycle.See Section 2-491 for more information.
_Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
Yes XNo: If.yes,.has it;been less than .12 months since the••elected:'offinial(s) whom you=provided.campaign
consulting services was sworn.in?
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service before lobbying the City Commission at a public meeting.
_Yes )(No: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
Yes No: If:yes, vire e .you.promised or'.did.you receive:economic:consideration :in exchange for campaign
consulting services?
l
TO BE COMPLETED BY CITY CLERK'S AFF ONLY
11
Annual Registration fee [ ]Yes[ No Amount Paid$ MCR# C,iI Date Paid
Lobbyist Registration Form received and verified by
F\CLER\$ALL1akiiiii\LOaBYF51r FORN9S\Lobbyist Registration F.orm Revised 03.1i 20 REG doo •Revised;03/11/.2020
,, Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LO: .Y. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR TION D "l r(1. THE REPORTING PERIOD.'
Signature of Lobbyist:' Date 6,
I do solemnly swear or a rem that all pkthe foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar Wit the provisions contained,in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City and al rep in requirements.
Signature of Lob yi Date C *_222----
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of
County of: Miami-Dade County of: •
Sworn to(or affirmed) and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of El physical presence by means of❑ physical presence
or 0 online notarization, or 0 online notarization,
this 18 day of JUNE .20 22, by this_day of 20_, by
Don Peebles
NAME OF LOBBYIST NAME OF PRINCIPAL
X Produced ID Driver's License _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personally Known _Personally Known
Signature of Notary Public Signature of Notary Public
Emile Dominique
Name of Notary, Typed, r" • or Stam•ed Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) °•',,•A'. y PublicE
DOMIn'l:J_ L
::=F ; •,� Notary Public-st;, , � , (NOTARY SEAL)
\..Yr
?rir Comm 5
IV My Expires
,.., 1a, 1012 r
3 Bonded through National Not a; nss
1 The term"lobbyist"specifically excludes the following persons: Y"
Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
1
MIAMII )
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
NAME OF LOBBYIST: Don Peebles
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition' to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall, be assessed for Statements filed after the
due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and
Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursua o Section 2-482 of the Miami Beach City Code.
6-1T-2
Sig ature o Lobbyi.t Date
F:ICLERI$ALLLaFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc
Page 5 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'
Signature of Lobbyist: Date
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist: Date
Signature of Principal: Date. tt 2--2--
VII. NOTARY SIGN TUR AND S AL:
LOBBYIST: PRINCIPAL
State of State of Florida
County of: County of: Miami-Dade
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of 0 physical presence by means of lii3 physical presence
or 0 online notarization, or 0 online notarization,
this day of . 20_, by this 18 day of JUNE , 2022, by
Don Peebles
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID X Produced ID Driver's License
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personally Known Personally Known a
Signature of Notary Public Signature of Notary Pu.'
Emile Dominique
Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) (NOTARY SEAL) EMILE DOMINIQUE
: • :. Notary Public-State of Florida I
� tiP) Commission H GG 241654
r}°o- My Comm.Expires Jul 25,2022 F
Bonded through National Notary Assn. 0
1 The term"lobbyist"specifically excludes the following persons:
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct, indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
1664 Meridian Avenue, Miami Beach, FL 33139-Organizational Chart _
1664 Meridian Avenue
(Pro erty)
1664 Meridian, LLC (100%)
L22000122140
1
1664 Meridian Ave General
Partner, LLC (100%)
M22000003814
1664 Meridian Developer,
Meridian Ave Partners LLC
LLC (60%)
(40%)
L22000122137
1664 Meridian Peebles, LLC
SRC Merdian Ave Partners Baron Meridian Ave (100%)
L22000122132
LLC (100%) — Partners LLC (100%)
R. Donahue Peebles (100%)
Scott Robins 100°10 Earl Diversified Holdings
( ) LLC (DE) (100%)
Philip Levine, as Trustee
of the Philip Levine Trust
u/a/d March 24, 2021
Philip Levine (100%)
•
Miscellane
ous Cash R •
eceipt
CITY OF MIA#1lt BEACH
No,428773 , .
aCash,. - }credit card ar #:.,
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(THIS INFORMAT/ON MUST BE COMPLETED) --
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Office of Flosoite
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